After an open reduction and fixation on my ankle, pain is constant. Why?

Question

Hi doctor,

I had open reduction and fixation on my right ankle after a fracture. I was in a cast for six weeks. The doctor took the cast off before 19 days. I was given a CAM boot and was told to use a CAM boot as needed and weight bear as tolerated. Doctor also said to me that I should be able to walk normally after three weeks. My next appointment is in the next two days, but my pain is constant and only worsens. It starts when I wake up and gets worse through the day. My ankle swells, making the CAM boot uncomfortable to wear, even when I bear weight as little as possible or use the CAM boot all day. Is this normal? I work in the ER, and I need to go back to work. I am just worried.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and had looked at the X-rays (attachment removed to protect the patient's identity) you have provided. And I can understand how this situation can be difficult for you.

First X-ray shows that there is a lateral malleolus fracture nearly reaching the ankle joint line. Based on the second X-ray which you have provided, the fracture appears to be healed well. Usually along with fracture, there will be associated soft tissue and ligaments injury, especially in cases like yours where the fracture line is reaching above the ankle joint. It would have been more helpful if the lateral view of the X-ray was available.

In such cases after fixation, the cast is removed after six weeks. After which advice is given for mobilization as tolerated. It can take up to six to eight weeks to achieve good mobility. Another thing is, as you have mentioned, your weight is in the range of 100 kg, recovery and weight-bearing can get delayed. I would advise you to start home-based stretching, range of motion, and strengthening exercises. You can look up online for lateral malleolar fracture exercises.

You also have your next visit to your doctor, where he can physically look and examine the ankle joint for mobility. Also, he might take another X-ray to see how the fracture has healed, and there is any remaining soft tissue swelling. Till then, I would advice you to continue tablet Protonix (Pantoprazole). If pain is not manageable, you can take analgesics like Diclofenac and Serratiopeptidase to reduce pain and swelling. If you can walk further than before, it means the ankle is recovering and needs some more time.

I would be happy to help you further if you have any more questions.

Thank you.